joyouter

With emphasis on your question regarding pain management and the epidemiological picture of pediatric Sickle Cell disease and management. the following link should be of interest. http ://www.ncbi.nlm.nih.gov/pubmed/12662119

I think this whole campaign to convince people people are crying bully prematurely was started by a bunch of bullies. And people who use sarcasm, eye-rolling, gossiping, information hoarding, disregarding your needs/concerns are just doing the socially acceptable form of bullying...but it's still bullying. There are many, many ways to make a person feel intimidated or threatened And will wear one down eventually........... . Interesting discussion. How would one define the difference between continual harassment ( on-going) vs. bullying. Can this be defined as a personal attack if the nurse has done nothing wrong and accusations are made consistently which are lies and have been refuted many times? Or can it encompass the physical reaction of a manager who will stare at you blankly when you request help or assistance at the mg mt. level? Then in the next moment, criticize you for working overtime to meet your extensive patient population load without acknowledging one`s workload.or that your work is excellent? ( coworker`s descriptions) Does such behavior meet the characteristics of bullying, sociopath behavior or simply part of nursing, especially when it is continuous over a year? Bullying or harassment can be defined as any type of consistent behavior from one or many persons against a specific person, to the point where there is psychological stress, physical symptoms and one has to work twice as hard to meet one`s goals. Burn out can result from all of the above, and yes it is bullying. There is a major difference and well defined need in nursing to adress an action an action where it may cause harm or where such an action has occurred and the results must be addressed, as part of learning and taking responsibility. Personal dislike, pre-judgement, jealousy- all of the green eyed monsters invoke actions of bullying and harassment and must not be ignored or brushed off lightly. they are signals of deeper psychological problems and affect nursing teams, in particular when managers feel it is their prerogative to exercise power through such tactics . . If we, as professionals, see and accept this as part of a normal behavior, then we, in turn, inadvertently support the very act by not adressing it at its core.

This is a very good discussion I worked in W. Africa a no. of years ago and was on call for emergencies 24/7. One night I received a call where a US citizen, a woman had eaten something in a local restaurant, was experiencing a possible anaphylaxtic reaction. Conscious but difficulty in breathing, hives.. Her colleague - a non healthcare person sourced her epi pen and gave her the injection while I was on my way to treat her. REad West Africa as having very limited hospitals and health care personnel. Fortunately I arrived just as she did, I rushed her to the treatment area, I called a local doctor who had been vetted, set up O2, iv fluids, iv benadryl and steroids in our clinic with ongoing vs monitoring. The background was that she simply carried an epi pen because she was in a 3rd world country. She did not know her specific allergy but was told by her own GP at home to carry an epi pen in case of unknown reactions because she was going to be working in a 3rd world country.. .The doctor arrived later and examined her. She did well, after careful monitoring, multiple doses of antibistamine and steroids and continued O2. While the majority of us live close to available health care facilities, the conditions of anaphylactic reactions prompt immediate reaction. In this case her life was saved by a lay person a friend who gave her the epi pen she carried. Would we carry an epi pen so routinely, probably not unless our medical history demanded it. However we do not know when unknown severe allergies can occur '..... Just food for thought.

Hi - as a new nurse medications can be confusing. Not wanting to preach but You need to review the medications, actions, types of vials and doses and how they are calculated. Try the following below; When you can sit in a quiet area and Get hold of a tuberculin and insulin syringe. Have another nurse or pharmacy if available. explain the differences as they do look very similar. Handle them, look closely at packaging and at syringe and needle size. Another point I find helpful is that even if you are using a pen or ad administering this medication via other routes. , always check the vial, name and dosage. There are many similar appearing medications today. So read the label first of all and secondly, have someone check the doses you draw up. Whether it is policy or not. Read up on heparin and understand how that is given. Heparin does appear in different strengths ie. 1000 iu per ml and for major infusions, I have seen 5000 units per ml. So it is vital that you read the label , know the medications your patient is taking and always be aware that allergies to heparin may occur ( not so often but still possible) Also be aware of the drug interactions. You raised good points here . Good luck

I see where the disconnect comes from. As i said,many employers around here request official transcripts from the schools attended. So yeah,when the employers do that,they can most certainly see if the school attended has a B and M campus attached to it. The discussion revolving around the merits of on-line vs B&M university studies continues. It is important to recall how a university is allowed to establish credit level courses in all subjects, nursing included and how it is ranked as a learing instituion.. * The university`s records, academic calender, academic profile of all employed teaches are examined for accreditation. * The university is ranked largely according to the level of published research which indicates a strong research department. * Publications are assessed annually * Most universities today have a percentage of on-line course work including B&M. Some B&M may not offer full courses to the same level as universities with well developed online leaning departments, but the choices are there. This reflects on-going current changes of delivery methods in learning therefore courses at B&M schools may contain partial on-line learning. * All online courses are closely proctored and students must deliver quality work- meaning that there is sufficient indication of independent thinking and research of all topics within that particular curriculum and course demands * The level of discipline, commitment and interest will direct the success of learning, whether on line or in B&M classrooms. * An on-line course will electronically measure when a student enters and leaves a discussion forum. Such forums as mandatory. Student assessment is based on participation, reflection on the topic of study for that day and ability to enrich with further findings, showing that the student has done her homework and is able to open new threads relative to topic and thus enrich discussions with new findings. *All on-line profs. monitor every students`input as everything is electronically documented and later assessed. One cannot get away with sporadic contributions unless there is is a personal reason. This must be shared with the teacher who will offer support and alternate choices. I have studied both On-line and B&M. The level of student commitment to success remains the same. When you want to succeed, you will learn to think of positive ways to adapt to studies to achieve. Today, every forward thinking university offers on-line studies - we are in a world of telecommunications- spurred on by Internet, websites and rapid access and sharing of data. We need to know how to maximize use responsibly and to remember that basic practical nursing can only be learned through real clinical teaching and experience, a vital part of rounding -out the nursing degree. One of the most helpful sources when trying to find good schools is to look at the Times University Ranking which is divided into many areas of specialties. It is designed for North America, Europe, Asia and Africa and is worthwhile to consider if uncertain. Joy. RN, RSM, BScN, M.Sc.

This was a poor first job experience. Working 4 12 hr nights as a new grad will decreased your focus, increase fatigue and affect job performance. The interview is bizarre and actually appears to more of an exercise as decisions had already been made re. your position. NEVER mind. Sounds like you got away at the right time. As an ICU / CCU nurse, I would advise that you look up training or revision of cardiac problems and polish up meds and ECG interpretation. That would spark interest and as you really want this position, it may be all to your favour. Let the manager and HR know what your plans re. cardiac nursing and learning are. This will help to move you forward. RE. job status. Look around at other areas with CCU`s - dont bank on a specific job with one employer, Do more homework on the hiring policies and remain aware of the probabtion periods in all new positions. Cardiology is a wonderful subject and I loved it - Good luck and go for it.

HELP!!!! This is my first nursing job on a med/surg floor. I have a meeting with my manager because other nurses are saying I don't know my patients and suspect I'm not doing my assessments. The real problem is that I have been put down so many times during report that I now get ridiculous anxiety and my mind goes blank. I really feel like my only option is to find a new job because now I'm on the radar. I work night shift , and the info needed for night shift is completely diff than what days needs to know. Plus they ask tons of questions about things that should be easy to see during assessment (should be easy to answer but my mind goes blank from nerves) First of all think about your actions at work. Are you organised, do you think systematically when assessing patients and their needs. Developing a system to organise patient name, diagnosis, treatments, allergies ( espec.) and ongoing events. such as ivt. when due etc. I know at report for night nurse shifts, day shift personnel also come with various approaches to work. Some will be genuinely interested and appreciative of your assessment skills which is very helpful to the next shift. Some will resent coming to work at all and their anger or put down will be reflected in how they address you or other colleagues with whom they feel free to harass. Don't let this get to you, remember their intimidating behavior is less than professional. You are new and struggling to learn the ropes. Only you can take responsibility and not allow yourself to be intimidated. If they are getting to you that strongly I would address it with your HN, or simply put it simply and state you are learning how to do a good job and you appreciate positive help from the team. If this does not work then the HN needs to be involved in assessing staff attitudes to co workers. remember; 1. Organise , use a brain sheet to help you .2. Be concise and in-depth in your assessments and reports. I know it is difficult but that is how you will learn and develop your skills. Good luck and be strong.

Experience comes in many different forms. This is one of them. Hang in there!! Big HUGS - and like so many other posts, ask for counseling to assist you through this period of grief and anxiety. Just remember there are some key learning points from this experience which you stated already. Now you have to remember them for future use in patient care. 1. If you are ever unsure- ASK FOR HELP.. NO ONE WILL FAULT YOU FOR THAT. You will save yourself so much anguish and possibly the life of the patient. 2. You felt insecure at that time but did not ask - that is a big clue to your situation. Were you stressed or simply wanted to show that you were competent. - Not smar. Now you need to learn how to react through this steep learning and painful curve for all future care. 3. Remember ASK- I think that there is no nurse no matter how many years of experience and knowledge, who has the right answer to every clinical situation today. I still ask when I am not sure. 3. You are a new nurse. Your learning is steep as you enter clinical practice. Everyone will be there to help you. There may be a few who will put you down, but you will learn who is supportive and who is not. Your communication skills and learning will be greatly enhanced as well as slowly building your clinical skill and competence level. 4. Most important, remember asking is not a sign of weakness. It is smart and responsible. 5. Take this time to heal and to learn from the experience. if you choose nursing, then all the very best. You will have learned from this error. God Bless and take care

There is nothing wrong with the email. Nursing code of dress is an age old topic and although Nursing students today are not expected to follow a strict uniform code, they still need to convey a sense of professionalism, representative of the profession which is health care. Patients react to us , their nurse with trepidation and will feel insecure. Dress code in any healthcare facility conveys the sense of professionalism. Practically it is also part of infection control and serves not only to protect patient buts also staff. Whether nurses work in community health or tertiary care, how we appear and present ourselves to the client is part of the patient/nurse relationship and embodies respect for self, client and professional practice. Don;t worry you will be just fine.

Actually, that's another topic and thread altogether. This thread focuses on whether or not consideration is given to the type of school that you graduated from and whether or not an online education is viewed as inferior. Yes, that is likely. However, the thread of GPA arose during the discussion of the merits of online vs B&M university programmes and how it is judged and demanded by employers.To summarise- I am in agreement with the statement that most on-line nursing programs were designed for post RN diploma nurses. In fact, many on-line nursing programs clearly state this as a pre-requisite, a concept I endorse. Thus, despite the meandering off the topic of merits earned through on-line vs BM institutions. an underlying concept remains - that of the nurse bringing her own clinical experience when considering post RN to BSN studies and the university evaluating her clinical experience, academic background and references for admission.. Thanks for pointing this out Yes, GPA could certainly become another thread for discussion.

Some considerations during this discussion are; 1. In what specific light are GPA results examined when hiring a nurse- her level of physical competency vis-a-vis her academic background? 2. How can this practice be justifiable when other professions in healthcare may or may not have their GPA examined by prospective employers? 3. Academic learning is one part of nursing practice as many of us are aware. The discussion recently revolved around new graduates with advanced nursing degrees and limited nursing practice. The results have been less than stellar. 4. GPA unfortunately does not measure cognitive thinking, motor skills and reactivity. It is a direct measurement of the sum of all academic courses which the student has successfully passed and graduated with diplomas at their institution of learning. 5. If hiring institutions insist upon nursing GPA results, does this apply across the board for all prospective newly hired workers at that institution? If this is NOT being applied as part of that institutions`s overall hiring policy, then yes, I think the practice does display some degree of differentiation towards nursing professionals. 6 On reflection, consider the level of responsibility and knowledge required at upper management levels- are their GPA results considered or is power so concentrated at that level that objectivity and yes, ethical considerations are lost.

I think that online education today is very much part of learning. There are many top notch universities with excellent programs. I also see a need for clinical practice with clinician teachers in a healthcare setting. Both can function well. The keynotes within this post demonstrates the presence of commitment. organization and love of nursing. Online learning as supportive, further background knowledge works well when the student is disciplined and focused on the subject. There is no difference in desirable student characteristics at that point. What online learning does is to ensure that in depth reflection and adequate knowledge is present especially within on-line forums ( for which students are assessed) There is a quality of content and discussion because each is responsible for their input and must follow clear guidelines to material , discussion and a wealth of research based articles. A major difference between the two modes of education is that the student is visible to the professor, there are definite interpersonal relations being established and both are subjected to real human emotions which can affect interpersonal relations and color attitudes- a definite influence psychologically. Having said that, one can experience equally the same stressors on -line with professors. Today, amidst the stressors of work, family and financial obligations, the use of on-line in combination with clinical studies and supervision can work well. It remains for the student to research thoroughly all courses and believe in one`decision.

You appear to have been placed in an unfortunate and rather unsafe position. You are a new grad and thus require ongoing training and mentoring, preferably at a teaching hospital where new grads will be trained. It is also vital that you re-read your posting as you have already identified red flags that will affect your career unfavorably. This is due to the fact that you are hired to fill a position without the knowledge and skills that are mandatory. You state that you have a DON who does not like it if you call a doctor. That is ridiculous!! It appears this job has elements of abuse, bullying and a real lack of support. Please stop beating yourself up and rather focus on how you can be better organized when seeing patients. ie. carry a pack with some basic needs such as small sharps container etc. tools you will need for basic patient assessment and do not be afraid to call a doctor re. any prescription. If your DON is bullying you then this also needs to be confronted. You have identified areas where he is not often available, when he should actually be available to you especially as a new graduate thus he is not doing his job competently. This is another unsafe practice, especially if he is aware that you are a new graduate..... So focus upon what you need to do to protect yourself and your patients and document everything that occurs systematically, ie. date, time, incident and result. You need this as part of your own accountability and will help you in the long run

This was a great article and I was reminded of how much I missed my IV Team practice. I have worked in many settings as IV NUrse but the best and most enjoyable experience was getting the IV team set up and running. This was in a multicultural hospital where many nurses were unfamiliar with the concept. We rapidly developed into a multidisciplinary team, providing inservices, starting iv certification courses, working with Infection control and working with pharmacology to reinforce awareness of medication, iv administration, incompatibilities, Central line infection control, care and trouble shooting. We evaluated new infusers, needles and other aspects of iv care including Port-a-caths. I left to return to school but always remember that period with fondness. Nothing can equate a patient who, after fearing pain on iv. sticks, smiles and says that was fine.... The positive joys of IV nurses. Hospitals should not have eradicated them but sought to incorporate these skilled members into other areas such as day surgery and preop care. Congrats to all IV nurses.on IV NUrses Day

This article truly highlights exactly the depths of indifference, incompetence, greed and immoral practice which has been imposed upon nursing practitioners. Management has accepted all acts of power mongering and bullying tactics as key to nursing control- a form of corruption. How this impacts health care, both in quality care and cost amounts to almost criminal intent. The sub-human treatment of seasoned nursing colleagues by inexperienced nursing management with advanced degrees demands legal advice. The reality is that all nurses and patients are being placed under attack through misguided, poor managers with non existent decision skills. Health care, education and social stability are key aspects of democracy, good government and accountability. A break down in any of these areas negatively affects everyone with serious secondary run off effects. . It is time this was collectively exposed by nurses in practice to the public. Nurses are not disposable commodities and their role in healthcare cannot be underestimated. All nurses applying for Executive Management jobs in nursing need to be tested and thoroughly examined re. their ability to manage, to think and to assess problem solving and interpersonal skills. levels of reactivity, subjectivity and objectivity in practice need to be measured. This is the routine applied to other executive managers in any industry. Business managers have to be put through such testing due to the need for the right fit for the job. Nursing does not apply these rules and the consequences, having been ignored as management competency is not thoroughly examined. Rather when faced with management dilemmas, the preferred practice has been to hire externally, a non health care professional with multiple MBA or management degrees. This has proven over and over again, how incompatible this is in a healthcare setting. Nurses are educated, competent professionals and unfortunately, this often proves incompatible to new, highly qualified, non healthcare professionals who desire to see nurses as little more than bedpan givers without the ability to think, as this further feeds the new managers sense of power. The consequence as we know, is always disastrous. Nurses can make good managers. Not every nurse wants this and not every nurse can do this particular job. Two mandatory words stand out in healthcare and nursing, Experience and competence with education. If applying for management roles, nurses need to undergo similar testing for the appropriate fit. This is not to say that nurses do not make good managers, it is rather to assess where in management they actually belong, thereby ensuring continuity in best practice at all levels of the profession. WE, as nurses, know what is needed, what works and what does not. Being able to assess the right fit and have further training is crucial to eradicate the level of incompetence and quasi-corruption right now.

Contrary to popular belief, nursing and management courses taught as part of BSN programs do not adequately address the real issues of managment and personnel interaction. This thread addresses two issues being inadvertently discussed right now 1. Competent reflective management and managers 2. Ethnographic theory and multicultural paradigms as observed and practiced in management, ie nursing interactions. This approach is probably the most realistic and observant re. belefs , behaviours and other cultural aspects which are seen and experienced in groups. Ethnographic theory forms a strong part of management. There are numerous texts on management which nurses need to research as most nursing management texts skim the surface of management theory. Modern management texts address inter cultural conflicts, beliefs and behaviors in depth and cosider how this influences the bottom line and productivity albeit company vis-a vis health care. Obviously both areas do consider costs and effect alongside productivity and the negative fall out from cultural incompatilbility or lack of knowledge at that level. Furthermore, consideration of the global impact from ethnology/cultural disagreement forms part of this paradigm. Management demands strategic thinking, understanding and analysis, not only short term but for long term perspectives. It is the ability to effectively observe, deduct and understand human dynamics especially in conflict ridden environments. This also means having the ability to objectively observe, understand, empathize and develop good, effective strategic planning based on said observations. Nursing education does not offer this as yet. Joy ( RN, BScN, MSc Strategic HRD, MA ( Global Change and Adult Learning- in process)

I think this depends on many issues. The size of the Foley catheter being used, The effective use of lidocaine jelly ie. to leave it in place long enough for the anesthetic action to work, the ability to locate the urethra and introduce the Foley smoothly and the reason why the catheter is being introduced. As a midwife and OB nurse, catheter insertion is necessary for mothers in labour with epidural catheters because the sensation of voiding is lost once the epidural effect starts. A full bladder will actually impede active labour and may cause residual damage to the bladder and urethra. When and obstruction is met, especially in men with enlarged prostates or in women with UTIs, (non pregnant or pregnant) the size and methodology of both catheter and skill remains tantamount to patient comfort. Patient explanation and trust is key alongside good technique with limited pain. Above all, it is worthwhile to always consider why the patient needs the Foley inserted.

The original post addresses the very strong negative behaviors which re-occur daily. Human relations are always an unknown paradigm. perhaps signaled by the root suspicion and innate fear of not being accepted, being misunderstood ( deliberately or otherwise) - all of which can be possibly related to our human ancestors -thousands of years ago, when newcomers were perceived as a threat. As a so -called advanced society, most of us learn how to dodge bullets ( real and imagined) and to act as responsible professionals with dignity and pride in our practice. Many of the above negative behaviors are not addressed because as nurses we are totally focused on being accountable in our actions delivering safe, legal quality care. The aspect of bullying is really the undercurrent being discussed and has pervaded nursing for many decades. It is the most destructive, immoral behavior and does nothing to maintain professionalism, rather it blocks and blinds those who are bullying and promotes fear and high levels of anxiety in the victims. Cultural groups have always ganged up on those who are less represented. Nursing research, nurse managers have never been able to address this phenomenon and the denial and inability to address it further feeds this vicious cycle. . Is it induced by the very fact that caregivers are not taught to self care to be able to cope with almost inhuman stress occurring in healthcare today- nursing is about giving care, but does not address the emotional drain from constant giving and caring for others. From another perspective, can we ask if this behavior stems from a deficit in learning or fear of openly acknowledging this painful process at levels top down throughout the nursing ranks.. It must also be remembered that those who bully usually align with others with similar deficits in cognitive behavior and weak egos - which results in a self feeding process spiraling out of control. Why is it globally that there is such a nursing shortage today. Bullying in any form from despotic dictators to the nurse working with patient care, all have similar outcomes, tragic loss of personnel, of life at times and loss of practiced skillful professionals who refuse to be part of a dysfunctional group. Questions of culture and language within a limited group become weapons of power to reinforce a sense of power in any particular ethnic group, often preceived rather than real.. . The over arching question is how can it be addressed and will it be addressed. Can nursing education actually develop a course for nurses to assist in defusing such behavior presenting evidence as to why it occurs and how it can be addressed through self reflection. Can nurse managers be better trained in conflict recognition and resolution with specalist support. Confluct among human beings will always exist in varying degrees. With that in mind, nursing professionals are challenged to find a better way.

Agree withe the above. I was thinking of my own experiences, having worked in critical care for many years, the unit hours shifted from 8 to 12 hr shifts. We voted on this change and the end result was 12 hr shifts initially. After a no. of years, all 12 hr nurses voted to work part time with 8 hr shifts. This was a multidisciplinary ICU ( med with surg and isolation rooms) The level of fatigue was higher especially after working 12 hrs in an isolation chamber with full gear. I don't think that has changed. Both types of shifts can induce errors, based largely on the levels of patient care, associated stress, risk factors and physical fatigue. RE; Informed questions, media need to do their research for responsible reporting. Sensationalism does nothing but promote guess work, panic and dis-information. Just as we as health professionals are expected to act responsibly, ask when we don't know and source correctly, media representatives also have to act responsibly and report accurately... something that is forgotten or ignored during crises. Hard to do , but a modicum of common sense must prevail as well. Thanks for listening.....

The blame game is always the method applied when no one can or wants to ask more pertinent questions examples 1. Was or has the hospital system ever addressed the high risk of infection and epidemiologic characteristics of such a virus. An honest response would be No, because this is a tropical virus and we have not been informed of its nature and virulent characteristics. 2. How safe are the protection gear used in these cases - is there evidence based knowledge on the issue ? 3. Are the various health authorities exploring the efficacy of the present gear and if so, will this be upgraded to protect staff ? 4. how far along are the various vaccines and treatments ? 5 12 hour shifts are brutal for nurses working in all departments.. Has this been addressed to alleviate stress and prevent fatigue based mistakes. ? 6. How are staff being cared for while they care for Ebola patients. Are they well nourished, hydrated and receiving needed services to maintain health and well being «? Ebola places health care personnel especially nurses in the front line.. How effectively has this been addressed.«? These are the issues that all media and healthcare management need to address now.

I have suspected that the "breach in protocol" may end up being a breach in the protocol the CDC recommends or that Emory used (e.g. space suits) vs the actual protocol that the Texas hospital had their staff use. The nurses involved may not have removed PPE incorrectly, they may not have had the correct PPE. This is purely speculation on my part, but we don't know the entire story and maybe never will. As a staff nurse, you can only use what your facility supplies as far as PPE. Walmart doesn't sell space suits--yet. Most of us trust that when dealing with something as potentially lethal as Ebola, our employer will take the necessary measures to protect us. What we don't know can hurt us. Excellent point. Moot point, since Ebola only just arrived in the US, How do CDC know that the recommended gear will function efficiently in such a highly conatagious case. some questions to consider 1. Where were these suits monitored or tested under such extraordinary infectious conditions 2. Are the gloves adequate- everyone knows that protective material can wear down after continuous contact. Do better quality gloves need to be supplied 3. What were the construction of the masks or resp. protection. Feces emits odour and viral spores, increasing as the patient becomes more infectious and circulates within the room each time a patient has diarrhea. Bleeding is also involved thus increasing risks esepcially if blood droplets dry and are released into the room 4. Have these masks been tested in highly conatagious environments and what is their half life of efficacy. 5. Instead of quoting a quasi protocol, CDC and epidemiologists need to re examine the above and bear in mind that the longer a nurse is in a patient`s room, the more likely risk of infection. If no facts are known about the shelf life and protective qualities under these circumstances then that is where the focus should lie, not on the nursing staff Just a few thoughts......

CNN and Erin Burnett should be requested to issue an apology for sensationalism using a deady virus and nursing as a scapegoat. The media are at fault for putting their feet in their mouths without adequate proof, in-depth knowledge and the punitive knee jerk reaction to immediately ** blame the nurse** !! how many of us are really fed up and disgusted with the continuing negative picture that is instantly sourced to attract viewers and the public when nursing remains a red flag to viewers. Ebola presents enormous challenges to every health care professional involved. The primary fact is that it is highly contagious and this element increases with the longevitiy of the disease in any infected patient, thus placing everyone at risk. If sensationalism is the only objective, then CNN need to present their facts to educate the public, not point fingers.

That is great news. How was this measured- and how accurate are these facts. not meaning to be a downer but if these facts are accurate then there is a lot to be learned by many epidemiologists and infection control specialists.

The nurse in Spain is a Nursing assistant who attended to a priest, who died from Ebola. Just for clarification